Nexplanon Subdermal Implant: Assessment of Sexual Profile, Metabolism, and Bleeding in a Cohort of Italian Women.

OBJECTIVES: To evaluate the impact on metabolism, bleeding, and sexual function of Nexplanon, a subdermal implant. STUDY DESIGN: We recruited women (n=101) receiving the Nexplanon implant at two university centers in Italy between 2011 and 2016 into this prospective, observational, multicenter research trial. Participants completed the Interview for Ratings of Sexual Function (IRSF) and the Female Sexual Function Index (FSFI) questionnaires before and 3 and 6 months after the implant was inserted. In addition, all blood parameters were assessed at these visits. All women were given a menstrual diary card and a pictorial blood assessment chart to record daily any vaginal bleeding. RESULTS: The studied metabolic parameters remained in the normal range, showing no alarming modifications: minimal statistical reductions (in aspartate aminotransferase, alanine aminotransferase, total cholesterol, triglycerides, and activated partial thromboplastin time) and increases (in glucose and prothrombin activity) were observed. Changes in IRSF score over 6 months showed a significant increase in pleasure, personal initiative, orgasm, intensity of orgasm, and satisfaction, and a significant decrease in anxiety and discomfort. Mean Body Mass Index decreased, and the weekly frequency of sexual intercourse increased. CONCLUSIONS: Nexplanon showed not only a lower metabolic and bleeding impact, but also important positive effects on sexual function. It expands the range of possibilities for women, 38 and couples, in the modern concepts of sexual and reproductive wellbeing.

Ultrasonographic evaluation of urethrovesical junction mobility: correlation with type of delivery and stress urinary incontinence.

INTRODUCTION AND HYPOTHESIS: A relationship between urinary incontinence and hypermobility of the urethrovesical junction (UVJ) during pregnancy has been described. The aim of the study was to compare the effects of vaginal delivery (VD) and caesarean section (CS) on UVJ mobility. METHODS: The retrovesical angle (RVA) and the anterior angle between the UVJ and the pubic bone, the pubovesical angle (PVA), were evaluated ultrasonographically in controls and pregnant women during their first pregnancy between 38 and 40 weeks, and then re-evaluated 6 weeks and 6 months after delivery. All patients completed a validated questionnaire (ICIQ-SF). Differences between and within groups were assessed with Student's t test, the chi-squared test for trend, and one-way two-tailed analysis of variance with Scheffé's post-hoc test. The correlation between PVA and RVA was evaluated using the Spearman R correlation. The positive predictive value, negative predictive value, sensitivity and specificity for the prediction of stress urinary incontinence (SUI) symptoms were also determined. RESULTS: Included in the study were 42 controls and 217 pregnant women. PVA at rest, during cough and Valsalva manoeuvre was significantly higher in pregnant women than in controls and in women 6 weeks after VD in comparison with women who had undergone CS. Patients affected by SUI showed a significantly higher PVA. RVA did not differ between subjects affected or not by SUI symptoms. PVA and RVA were not correlated with each other. CONCLUSIONS: PVA and RVA are increased in pregnant women in comparison with controls. In patients undergoing VD, PVA is restored significantly later than in those undergoing CS. The change in RVA after pregnancy and delivery seems to persist longer than the change in PVA.

Pharmacological treatment of urinary incontinence.

We present an overview of the current pharmacological treatment of urinary incontinence (UI) in women, according to the latest evidence available. After a brief description of the lower urinary tract receptors and mediators (detrusor, bladder neck, and urethra), the potential sites of pharmacological manipulation in the treatment of UI are discussed. Each class of drug used to treat UI has been evaluated, taking into account published rate of effectiveness, different doses, and way of administration. The prevalence of the most common adverse effects and overall compliance had also been pointed out, with cost evaluation after 1 month of treatment for each class of drug. Moreover, we describe those newer agents whose efficacy and safety need to be further investigated. We stress the importance of a better understanding of the causes and pathophysiology of UI to ensure newer and safer treatments for such a debilitating condition.

Pharmacological approach to overactive bladder and urge urinary incontinence in women: an overview.

Besides life-style changes, electrical stimulation or surgery, pharmacological treatment is becoming the first-choice approach in women suffering from lower urinary tract symptoms (LUTS), including urge urinary incontinence (UUI) and overactive bladder (OAB). Several drugs for the treatment of bladder storage and voiding disorders are currently available and, in the near future, novel compounds with higher specificity for the lower urinary tract receptors will be accessible. This will bring optimization of therapy, reducing side effects and increasing compliance, especially in patients with comorbidities and in women. The purpose of this paper is to give an overview on the pharmacotherapy of two common inter-correlated urological conditions, UUI and OAB. The study was conducted by analyzing and comparing the data of the recent international literature on this topic. Advances in the discovery of pharmacological options have dramatically improved the quality of life of patients affected by incontinence, but further studies are needed to increase the effectiveness and safety of the therapies used in this field.

Uterus didelphys: report of a puerperal torsion and a review of the literature.

A 29-year-old Para 2 was admitted to the emergency department with increasing lower abdominal pain. The patient had undergone an uncomplicated elective repeat caesarean section 7 days before being admitted to the emergency department. An emergency laparotomy revealed a uterus didelphys with a torsion of one of the uteri.